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PubMed1999

The relation of premorbid factors to aggressive physical behavior in dementia.

Aggressive physical behaviour (APB) is common in persons with dementia and often leads to negative consequences such as use of restraints and staff member burnout. For the past several years, a group of nurse researchers has collaborated to develop a model that views dementia behaviors as need-driven but dementia-compromised. The model posits that background variables of the demented person interact with proximal (or current situational) variables to produce APB. The purpose of this study was to test a part of that model by addressing the question: Which premorbid factors predict APB in a sample of 84 demented institutionalized elders? This was a cross-sectional descriptive study that obtained measures of the following characteristics of residents: (1) aggressive behavior as assessed by nursing home staff members using the Ryden Aggression Scale, (2) premorbid personality traits as assessed by a member of the resident's family using the NEO Five Factor Inventory and (3) history of psychosocial stress as assessed by a member of the residents' family using the modified Social Readjustment Rating Scale. Of the sample of 84 residents, 44% exhibited physical aggression. Background factors in the model were not predictive of aggressive behavior in late-stage dementia, although the relation between premorbid neuroticism and physical aggression was in the predicted direction.

Aged↗
PubMed2005

Low density lipoprotein--receptor (LDL-R) gene mutations among Filipinos with familial hypercholesterolemia.

BACKGROUND: Familial Hypercholesterolemia (FH) is an autosomal dominant disease resulting from mutations of the LDL (LDLR) receptor gene leading to a diminished catabolism and elevated level of LDL cholesterol (LDL-C). It is associated with an increased risk for cardiovascular disease (CVD). The MEDPED (Make Early Diagnosis-Prevent Early Death) program, an initiative cited by the WHO Human Genetics Programme in their report on FH, initiated international collaboration to identify and follow-up patients with FH globally. From Asia-Pacific, only 6 countries are participating and no data among Filipinos particularly on genetic profiles is available at present. This study attempts to initiate data collection and participation in the global initiative. OBJECTIVES: Primary: 1. To describe the phenotype of Filipino patients with FH. 2. To determine and characterize the LDL-R gene mutations among Filipino patients with clinical features of FH. Secondary: To determine the association of the clinical characteristics of FH with the presence of LDLR gene mutations. DESIGN: Cross- Sectional Study. SETTING: Multicenter, Outpatient Clinic. PARTICIPANTS: 60 unrelated patients, 18 y/o and above from UP-PGH, Manila Doctors Hospital and Cardinal Santos Medical Center. FH was diagnosed according to the Dutch Lipid Clinic Network Criteria cited by WHO which is based on a history of premature CVD, family history, tendon xanthoma, arcus cornealis, and LDL C levels. METHODS: With informed consent, clinical history, physical examination and lipid profile data were determined. Blood samples were extracted, processed to isolate DNA specimens at the National Institutes of Health, Institute of Human Genetics, and sent to Canterbury Health Laboratories at Christchurch, New Zealand for DNA analysis. ANALYSIS: Descriptive statistics, Fisher's exact test and Student's t-test using Stata version 6.0 software. RESULTS: Sixty patients with a mean age of 55 y/o were included, including 39 (65%) females. The mean LDL level was 227 mg/dl. Cardiovascular Disease and a family history of dyslipidemia were present in 55 & 60% of the samples, respectively. Twenty percent had documented LDL-R gene mutations. Six of the mutations were considered novel. A family history of dyslipidemia, an elevated LDL-C level, and a high FH score exhibited a statistically significant association with mutations. The study population has a high prevalence of CVD at an average age of 55 years with a strong family history of dyslipidemia and very high average LDL-C levels. One out of every 5 patients had LDL-R gene mutations, 6 of which were considered novel. LDL-R gene mutation was significantly associated with family history of dyslipidemia, LDL-C Level and FH score. CLINICAL AND RESEARCH IMPLICATION: This is the first international collaborative genetic study among Filipinos with FH. Data could allow the country to participate in the WHO/MEDPED global program. Collaborative efforts will lead to more effective detection, treatment and prevention of CV events. Novel mutations were discovered and further analysis of these genes will be done.

Adult↗
PubMed2005

Missed expectations? Physicians' views of patients' participation in medical decision-making.

OBJECTIVE: Physicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process. DESIGN: This was a qualitative cross-sectional study of physicians' reported attitudes and practices. SETTING: The study took place in private practice and academic physicians' practices. PARTICIPANTS: A total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study. MEASUREMENTS: We performed a qualitative analysis of semistructured individual interviews. RESULTS: The physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process; others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors. CONCLUSIONS: The physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate.

Academic Medical Centers↗
PubMed2005

Nurses' and physicians' sedation practices in Danish ICUs in 2003 A national survey.

OBJECTIVE: The aim of the study was to describe and compare physicians' and nurses' estimated use of sedatives and analgesics in patients requiring mechanical ventilation in Danish Intensive Care Units (ICUs) in 2003. DESIGN: Questionnaires were mailed in January 2003 to all Danish ICUs providing mechanical ventilation (n = 48). One physician and one nurse at each site were included in the study. RESULTS: Thirty-nine questionnaires were returned by physicians (response rate 81%) and 43 by the nurses (response rate 90%). Physicians and nurses agreed that sedation related decisions are predominately made during rounds and that most decisions are made by physicians and nurses collaboratively. Only 9% of the nurses and 23% of the physicians reported using a written protocol for sedation, while 30% of the nurses and 44% of the physicians reported the use of sedation scoring systems. The study generally supported the hypothesis, that nurses' and physicians' would respond similarly, but there were, however, significant variations, regarding formal sedation practices. CONCLUSIONS: Sedation decisions are made collaboratively by nurses and physicians, while sedation protocols and scoring systems are still not systematically implemented in Danish ICUs. The most common drugs for sedation of the mechanically ventilated patient are propofol and fentanyl by continuous infusion. It is recommended that the ICUs collaborate on developing evidence-based standards for sedation and that clinical databases are introduced, which may be used to assess the efficacy of such standards.

Anesthetics, Intravenous↗
PubMed2003

Mechanism of the PII-activated phosphatase activity of Escherichia coli NRII (NtrB): how the different domains of NRII collaborate to act as a phosphatase.

The phosphatase activity of the homodimeric NRII protein of Escherichia coli is activated by the PII protein and requires all three domains of NRII. Mutations in the N-terminal domain (L16R), central domain (A129T), C-terminal domain PII-binding site (S227R), and C-terminal domain ATP-lid (Y302N) of NRII result in diminished phosphatase activity. Here, we used heterodimers formed in vitro from purified homodimeric proteins to study the phosphatase activity. A129T, S227R, and Y302N mutant subunits and A129T/S227R, A129T/Y302N, and S227R/Y302N double-mutant subunits formed stable heterodimers and were amenable to analysis; heterodimers containing these mutant subunits in various combinations were formed and their activities assessed. Complementation of the PII-activated phosphatase activity was observed in heterodimers containing S227R and Y302N subunits and in heterodimers containing A129T and Y302N subunits, but not in heterodimers containing A129T and S227R subunits. Complementation of the PII-activated phosphatase activity was also observed in heterodimers containing A129T/S227R and Y302N subunits, but not in heterodimers containing A129T/Y302N and S227R subunits. Finally, inclusion of an S227R/Y302N subunit in a heterodimer with a subunit having wild-type phosphatase activity resulted in a dramatic decrease in phosphatase activity, while inclusion of an A129T/S227R subunit did not. These results suggest that the phosphatase activity of NRII requires the collaboration of the PII-binding site from one subunit of the dimer, the central domain from the same subunit, and the ATP-lid from the opposing subunit, in addition to the undefined N-terminal domain requirement(s).

Binding Sites↗
PubMed2002

Collective directed transport of symmetrically coupled lattices in symmetric periodic potentials.

A mechanism responsible for the directed transport of symmetrically coupled lattices in a symmetric periodic potential is proposed. Under the action of an external wave that breaks the spatiotemporal symmetry and introduces inhomogeneities of the lattice, a net unidirectional current can be observed, originating from a collaboration of the lattice (periodic potential and mutual interactions) and the wave (amplitude, frequency, and phase shifts). Mode-locking induced resonant steps are observed and predicted. The directed transport can be optimized and furthermore controlled by suitably adjusting the parameters of the system.

Journal Article↗
PubMed1999

Cross talk between adipocytes and their precursors: relationships with adipose tissue development and blood pressure.

Adipose tissue is an important source of angiotensinogen (AT). A possible involvement of increased plasma AT has been proposed in hypertension in obese patients, but growing evidence suggests also that the local renin-angiotensinogen system (RAS), giving rise to angiotensin II (AngII), may act as a distinct system from the plasma RAS. AngII stimulates in vitro the production and release of prostacyclin from adipocytes which in turn promotes the differentiation of precursor cells into new adipocytes (Darimont et al. 1994, Endocrinology 138: 1092-1096). Cross talk between adipocytes and precursor cells has been validated ex vivo and in vivo as (1) AngII stimulates specifically prostacyclin production, (2) both carbacyclin, a stable analogue of prostacyclin, and AngII promote the formation of new fat cells, and (3) AT (-/-) mice, which have decreased blood pressure (Tanimoto et al. 1994, J. Biol. Chem. 269: 31334-31336), exhibit both hypertrophy and hypoplasia of adipose tissue compared to wild-type mice (collaboration with Prof. A. Fukamizu, Tsukuba University, Japan). Altogether the data are consistent with an autocrine/paracrine mechanism implicating AT, AngII, and prostacyclin in adipose tissue development and suggest a new role for local AngII in addition to that of systemic AngII in blood pressure. Hormonal regulation of AT production from adipose tissue is also discussed.

Adipocytes↗
PubMed1999

On the concepts of amae and the mother-group.

Notwithstanding Freud's (1921) early linkage of psychoanalytic group psychology with patriarchal themes (i.e., father-leader), more recent findings suggest that the regression in group behavior in general, and in group psychotherapy in particular, tends to evoke frequent maternal ideations. In this connection, this article points to a phenomenological relationship between the individual's universal need to be at one with the internalized mother, as exemplified in the Japanese concept of amae and that of the Mother-Group. With amae serving as an explanatory construct for the group members' interpersonal relations (i.e., identifications and transferences), the idea of the Mother-Group ties in with the group entity's simultaneous supportive functions (i.e., "we are all in the same boat") coupled with its role as a collective arena for the reactivation of unconscious wishes for the nurturing mother of early childhood. In linking a Japanese psychological concept with another, which was developed in the West, I am disproving Rudyard Kipling's often quoted assertion that "never the East and the West shall meet." I was encouraged in this task by Takeo Doi's written comment to me that the idea of the Mother-Group "certainly can be linked with that of Amae. For instance, when the group functions as the Mother-Group, you can say that the participants are experiencing Amae in one way or another" (T. Doi, Sept. 17, 1993, personal communication). In an extended sense, one hopes this essay might even serve to revive our interest in the interrupted well-known early collaboration of psychoanalysts and of anthropologists, which had begun to forge a way to connect personality formation with its cultural context (LeVine, 1974). The insufficient attention paid to the influence of cultural factors on attachment behavior was recently decried by Bretherton (1997).

Child↗
PubMed2004

The Oxford clinical intranet: providing clinicians with access to patient records and multiple knowledge bases with internet technology.

The Oxford Clinical Intranet provides clinicians in primary and secondary care across Oxfordshire with: Access to information about their patients held on multiple remote disparate computer systems, including admissions and episodes, Laboratory Medicine reports, Radiology reports and hospital discharge letters. The patient records are managed using CSW Case Notes. Access to support and advisory information, developed both within the organization and collected from other sites and projects, a wide range of internal handbooks, directories and guidelines and links to external resources, including evidence-based resources, the Cochrane Collaboration and the NHS National electronic Library of Health. Automated retrieval and presentation of the support information that is contextually appropriate to the task being carried out by the clinician and the information held about the patient. For example laboratory reports are linked to handbooks and other reference sources using eLABook, a web-interfaced database subsystem. Internet technology has been used throughout, thus providing a thin-client architecture with cross-platform ability. Appropriate data standards have been used across the communicating systems and the intranet is compliant with the UK eGovernment Interoperability Framework. The intranet was developed at low cost and is now in routine use. This approach appears to be transferable across systems and organisations.

England↗
PubMed1992

Lipoprotein lipids in older people. Results from the Cardiovascular Health Study. The CHS Collaborative Research Group.

BACKGROUND: Cardiovascular disease is the leading cause of death and disability in older people. There is little information about the distributions of risk factors in older populations. This article describes the distribution and correlates of lipoprotein lipids in people greater than or equal to 65 years old. METHODS AND RESULTS: Lipoprotein lipid concentrations were measured in 2,106 men (M) and 2,732 women (F) who were participants in the Cardiovascular Health Study, a population-based epidemiological study. Distributions of lipids by age and sex and bivariate and multivariate relations among lipids and other variables were determined in cross-sectional analyses. Mean concentrations of lipids were cholesterol: M, 5.20 +/- 0.93 mmol/l (201 +/- 36 mg/dl) and F, 5.81 +/- 0.98 mmol/l (225 +/- 38 mg/dl); triglyceride (TG): M, 1.58 +/- 0.85 mmol/l (140 +/- 75 mg/dl) and F, 1.57 +/- 0.78 mmol/l (139 +/- 69 mg/dl); high density lipoprotein cholesterol (HDL-C): M, 1.23 +/- 0.33 mmol/l (48 +/- 16 mg/dl), and F, 1.53 +/- 0.41 mmol/l (59 +/- 16 mg/dl); low density lipoprotein cholesterol (LDL-C): M, 3.27 +/- 0.85 mmol/l (127 +/- 33 mg/dl) and F, 3.57 +/- 0.93 mmol/l (138 +/- 36 mg/dl). The total cholesterol to HDL-C ratios were M, 4.49 +/- 1.29 and F, 4.05 +/- 1.22. TG, total cholesterol, and LDL-C concentrations were lower with increasing age, the last more evident in men than in women. TG concentration was positively associated with obesity (in women), central fat patterning, glucose intolerance, use of beta-blockers (in men), and use of estrogens (in women) and negatively associated with age, renal function, alcohol use, and socioeconomic status. In general, HDL-C had opposite relations with these variables, except that estrogen use was associated with higher HDL-C concentrations. LDL-C concentration was associated with far fewer variables than the other lipids but was negatively associated with age in men and women and positively correlated with obesity and central fat patterning and negatively correlated with renal function and estrogen use in women. There were no differences in total cholesterol and LDL-C concentrations among participants with and without prevalent coronary heart disease and stroke, but TG concentration was higher and HDL-C lower in men with both coronary heart disease and stroke and in women with coronary heart disease. CONCLUSIONS: Cholesterol and cholesterol/HDL-C ratio were lower and HDL-C higher than previously reported values in older people, suggesting that lipid risk profiles may be improving in older Americans. TG and HDL-C concentrations, and to a lesser extent LDL-C, were associated with potentially important modifiable factors such as obesity, glucose intolerance, renal function, and medication use.

Aged↗
PubMed2026

Cross-Ancestry Proteogenomic Analyses Identified New Therapeutic Insights for Ischemic Heart Disease.

BACKGROUND: Most drugs target proteins, and proteome-wide genetic analyses in diverse populations could discover potential novel and repurposed targets for improved prevention and treatment of ischemic heart disease (IHD) beyond statin therapy. OBJECTIVES: The purposes of this study were to use cis-acting single nucleotide polymorphisms (cis-pQTLs) identified for plasma proteins in East Asians and Europeans to discover and validate potential drug targets for IHD. METHODS: We measured plasma levels of 9,520 (Olink/SomaScan: 2,923/7,297) proteins in a case-cohort study of IHD (1,976 incident cases and 2,001 subcohort controls) in statin-free individuals in the prospective China Kadoorie Biobank (CKB). Genome-wide association studies identified 2,895 (Olink/SomaScan: 1,301/1,594) cis-pQTLs for these proteins in CKB. Two-sample Mendelian randomization (MR) and colocalization analyses assessed associations of all available cis-pQTLs for these proteins with IHD in East Asians (n = 29,319 cases), with further replication in Europeans (n = 181,522 cases) and comparison with findings in previous MR studies. RESULTS: In CKB observational analyses, a total of 959 (Olink/SomaScan: 426/533) proteins were associated at false discovery rate-corrected P < 0.05 with IHD after adjusting for major IHD risk factors. Two-sample MR analyses provided genetic support for 54 unique (Olink/SomaScan: 36/28) proteins in IHD etiology. Colocalization analyses confirmed shared gene-protein-IHD associations (posterior probability of hypothesis 4 [PPH4] &#x2265;0.8) for 15 unique (Olink/SomaScan: 10/10) proteins, including 8 lipid-related, 3 inflammation-related, 1 blood pressure-related, and 3 alcohol-related proteins in East Asians. In Europeans, MR analyses of 12 non-alcohol-related proteins showed directionally concordant results for 8 proteins, with 5 having strong colocalization evidence of shared gene-protein-IHD associations (PPH4 &#x2265;0.8), including 4 lipid-related (proprotein convertase subtilisin/kexin type 9, LPA, APOE, cadherin-1) and 1 systolic blood pressure-related (fibroblast growth factor 5) protein. However, 4 proteins showed directionally discordant MR results, including 2 lipid-related (APOA5, SORT1) and 1 inflammation-related (transforming growth factor beta 1) proteins with strong colocalization evidence of shared gene-protein-IHD associations (PPH4 &#x2265;0.8). Comparison with previous MR studies revealed little consistency across studies in the number and identity of target proteins for IHD beyond well-established lipid-related (low-density lipoprotein cholesterol, lipoprotein(a), and triglycerides) or inflammation-related (interleukin-6) protein targets. CONCLUSIONS: The findings support a role for lipid-driven chronic inflammation in IHD etiology, and treatment strategies simultaneously targeting multiple lipid and inflammation pathways should be prioritized for further research to improve drug treatment of IHD beyond statin therapy.

Aged↗
PubMedDate not supplied

A cross-site qualitative study of physician order entry.

OBJECTIVE: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals. DESIGN: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data. MEASUREMENTS: Patterns and themes concerning perceptions of POE were identified. RESULTS: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions. CONCLUSION: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied.

Attitude of Health Personnel↗
PubMed2005

Interventions to prevent hypothermia at birth in preterm and/or low birthweight babies.

BACKGROUND: Hypothermia incurred during routine postnatal resuscitation is a world-wide issue (across all climates), with associated morbidity and mortality. Keeping vulnerable preterm infants warm is problematic even when recommended routine thermal care guidelines are followed in the delivery suite. OBJECTIVES: To assess efficacy and safety of interventions, designed for prevention of hypothermia in preterm and/or low birthweight infants, applied within 10 minutes after birth in the delivery suite compared with routine thermal care. SEARCH STRATEGY: The standard search strategy of The Cochrane Collaboration was followed. Electronic databases were searched: MEDLINE (1966 to May Week 4 2004 ), CINAHL (1982 to May Week 4 2004), EMBASE (1974 to 09/07/04), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004), Database of Abstracts of Reviews of Effects (DARE 1994 to July 2004), conference/symposia proceedings using ZETOC (1993 to July 2004), ISI proceedings (1990 to 09/07/2004) and OCLC WorldCat (July 2004). Identified articles were cross-referenced. No language restrictions were imposed. SELECTION CRITERIA: All trials using randomised or quasi-randomised allocations to test a specific intervention designed to prevent hypothermia, (apart from 'routine' thermal care) applied within 10 minutes after birth in the delivery suite to infants of < 37 weeks' gestational age or birthweight </=2500 g. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed and data were extracted for important clinical outcomes including adverse effects of the intervention by at least three independent reviewers. Authors were contacted for missing data. Data were analysed using RevMan 4.2.5. Relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence limits were calculated for each dichotomous outcome and mean differences (MD) with 95% confidence limits for continuous outcomes. MAIN RESULTS: Six studies giving a total of 304 infants randomised and 295 completing the studies were included. Four comparisons to 'routine care' were undertaken within two categories: 1) barriers to heat loss (four studies): plastic wrap or bag (three), stockinet caps (one) and 2) external heat sources (two studies): skin-to-skin (one), transwarmer mattress (one). Plastic barriers were effective in reducing heat losses in infants < 28 weeks' gestation (three studies, n = 159; WMD 0.76 degrees C; 95% CI 0.49, 1.03) but not in the 28 to 31 week group. There was insufficient evidence to suggest that plastic wrap reduces the risk of death within hospital stay (three studies, n = 161; typical RR 0.63; 95% CI 0.32, 1.22; typical RD -0.09; 95% CI -0.20, 0.03). There was no evidence of a significant difference in major brain injury, mean duration of oxygen therapy or hospitalisation for infants < 29 weeks' gestation. Stockinet caps were not effective (borderline significant for infants < 2000 g birthweight) in reducing heat losses.Skin-to-skin care was shown to be effective in reducing the risk of hypothermia when compared to conventional incubator care for infants 1200 to 2199 g birthweight (one study, n = 31; RR 0.09; 95% CI 0.01, 0.64; NNT 2; 2 to 4). The transwarmer mattress significantly kept infants </=1500 g warmer and reduced the incidence of hypothermia on admission to NICU (one study, n = 24; RR 0.30; 95% CI 0.11, 0.83; NNT 2 range 2 to 4). AUTHORS' CONCLUSIONS: Plastic wraps or bags, skin-to-skin care and transwarmer mattresses all keep preterm infants warmer, leading to higher temperatures on admission to neonatal units and less hypothermia. Given the low NNT, consideration should be given to using these interventions in the delivery suite. However, the small numbers of infants and studies and the absence of long term follow-up mean that firm recommendations for clinical practice cannot be given. There is a need to conduct large, high quality randomised controlled trials looking at long-term outcomes.

Humans↗
PubMedDate not supplied

Instrument development in the Italy-USA Collaborative Spectrum Project.

SCOPE: The Collaborative Spectrum Project aims to define subthreshold and atyical conditions not sufficiently characterized in the current diagnostic nomenclature and for which adequate assessment instruments are not available. This paper reports on the development and validation of new instruments to assess the spectrum of five psychiatric disorders. DESIGN: Three multicenter studies and one single-site study were conducted in Italy to assess the validity and reliability of the five spectrum interviews. Another cross-sectional study to validate the panic-agoraphobia spectrum has been conducted in Pittsburgh. SETTING: Outpatients attending various university clinics, university students and, in one Italian study, gym attenders were recruited for the studies. MAIN OUTCOME MEASURES: Five structured clinical interview to assess the spectrum of panic-agoraphobia (SCI-PAS), mood (SCI-MOODS), social phobia (SCI-SHY), and the obsessive-compulsive (SCI-OBS) and eating disorder spectra (SCI-ABS) were administered along with a diagnostic interview and a number of self-report and interviewer-rated instruments. RESULTS: All the domains of the interview showed high test-retest reliability (intraclass correlation coefficient > 0.61) and satisfactory internal consistency. Mean domain scores were significantly higher in cases than in controls and in patients with the disorder of interest than in patients with other disorders. Convergent validity was satisfactory for panic-agoraphobia, social phobia and obsessive-compulsive spectrum domains. Differences emerged between SCI-ABS and self-report instruments assessing eating disorders. A cut-off score for the panic-agoraphobia spectrum was defined and its clinical validity was tested. CONCLUSIONS: The psychometric properties of the five spectrum interviews are very satisfactory, and studies are currently ongoing to test the clinical validity of all the spectra. Subthreshold and atypical symptoms deserve attention in epidemiological investigation.

Cross-Sectional Studies↗
PubMedDate not supplied

Managed care and the nurse's ethical obligations to patients.

The goal of managed care is to control health care costs by such means as keeping people healthy and decreasing the length of hospital stays. This change in health care delivery has resulted in work redesign programs, lay-offs, cross-training, and the use of an increasing number of nonprofessional care providers. The challenge for nursing, as a result of these changes, is how to fulfill its obligations of fidelity and due care. The authors discuss these ethical responsibilities and the impact that managed care is having on the fiduciary relationship between nurse and patient. Four strategies that nurses can use to fulfill their obligations include engaging in personal reflection, communicating and collaborating, protecting patient's rights, and evaluating patient outcomes.

Beneficence↗
PubMed2006

Discursive patterns in multiprofessional healthcare teams.

AIM: The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions. BACKGROUND: Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team. METHODS: A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I. FINDINGS: The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus. CONCLUSION: These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

Attitude of Health Personnel↗
PubMed2003

Accidental injury: a neglected area within Primary Care Groups and Trusts?

Our objective was to assess accidental injury prevention activity within Primary Care Groups/Trusts (PCG/Ts), and current knowledge and attitudes towards accidental injuries and their prevention amongst PCG/T board members. We used a cross-sectional postal questionnaire survey design. Participants were board members of 51 PCG/Ts in Trent. The main outcome measures were prioritization of accidental injury prevention and factors influencing prioritization, perceptions of the accidental injury rates in the population served by the PCG/T, accidental injury prevention activity undertaken by the PCG/T, attitudes towards accidental injury prevention and towards the PCG/Ts involvement in accidental injury prevention, knowledge of accidental injury mortality, and beliefs in the effectiveness of interventions. Many (66%) PCG/T board members see accident prevention as the least important of the priority areas in the Government's health strategy for England. Half the PCG/Ts (49%) had formally discussed accidents at a PCG/T meeting, 34% had taken action and 29% had written an accident prevention strategy. The median number of agencies PCG/Ts were working with on accident prevention was 2. GPs held less positive attitudes about accident prevention than other board members (Z = -10.01, P < 0.001), but had a greater knowledge about injury mortality (Z = -3.92, P < 0.001). Health promotion leads had more positive attitudes towards accident prevention than other board members (Z = -3.70, P < 0.001). There were misconceptions amongst health promotion leads about the effectiveness of some accident prevention interventions. We conclude that there is little evidence of prioritization of accidents as an area for health improvement. Although some PCG/Ts are undertaking accidental injury prevention, a minority have demonstrated strategic planning with respect to accident prevention or collaboration with a wide range of agencies. Accident prevention and the PCG/Ts role within this are not viewed positively by all board members. Gaps in knowledge about accidents and their prevention are apparent. PCG/Ts will need help and support to fully develop their potential in preventing accidental injuries.

Accident Prevention↗
PubMedDate not supplied

Research on the frontlines of healthcare: a cooperative learning approach.

BACKGROUND: Evidence-based practice is a common goal in hospitals, but learning about research so that the practice can be done is often challenging for clinicians. OBJECTIVES: The aims of this study were to (a) develop a process that supports organizational and staff development while conducting research and (b) conduct a research study in the emergency department (ED) to examine patient population, satisfaction, and waiting room issues. METHODS: A multidisciplinary team of clinicians and scientists was assembled to learn and do research while evaluating the ED waiting room of a Level I trauma center. A cooperative learning method approach was used to teach research concepts as the study was designed and implemented. RESULTS: The team demonstrated their knowledge and understanding of research concepts by being involved actively in the creation and implementation of the preintervention study. Using information from photographs, observations, and a questionnaire, the team identified the following key dissatisfaction areas: (a) atmosphere (including comfort with environment, neatness and cleanliness, and noise), (b) telephones, (c) parking and thoroughfare, (d) professional behavior and staff presence (including personal attention), (e) security, and (f) triage and confidentiality. DISCUSSION: The model of working in partnership with researchers and using cooperative, collaborative research is an effective way to evaluate and address issues related to quality of care while learning about the research concepts needed to put evidence into practice.

Cross-Sectional Studies↗